Life-Threatening Expansive Sublingual Hematoma

Ribeiro, Ana Elisa; Silva, Walessa B.; Menezes, Sílvio Augusto Fernandes de; Kataoka, Maria S.S.; Alves-Júnior, Sérgio de Melo; Pinheiro, João de Jesus Viana

doi:10.1097/scs.0b013e3182a4c6b9

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…The tongue is a relatively well vascularized structure, receiving blood supply from the lingual artery and its branches. Cases of penetrating injury to the tongue resulting in disruption of the lingual artery causing edema and airway compromise have previously been described [ 10 , 11 ]. Several studies have also identified anticoagulation therapy as a risk factor for airway obstruction due to the formation of sublingual hematomas [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Acute airway obstruction requiring nasotracheal intubation following hypoglossal neuromonitoring: a case report

et al. 2023

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Background Intraoperative neurophysiological monitoring (IONM) is utilized for both the localization of critical structures and for real time detection and prevention of intraoperative neurological injury. Use of IONM to monitor the hypoglossal nerve is performed during neurosurgical, otolaryngological, and vascular procedures to improve surgical outcomes. There is a paucity of literature describing potential complications of IONM of the hypoglossal nerve, especially with respect to airway compromise. Here we present our findings regarding a case of acute airway obstruction following hypoglossal nerve monitoring. Case Presentation A 54-year-old male was admitted for left far-lateral craniotomy and microsurgical clipping of a left posterior inferior cerebellar artery (PICA) aneurysm. Following induction and intubation but prior to the procedure start, the patient was placed in the ¾ prone position with the left side up and his neck was flexed approximately 10 degrees. He then underwent placement of subdermal needle electrodes into the facial muscles, trapezius muscles, soft palate, and tongue for IONM. The procedure lasted 523 minutes and was completed without complication. However, approximately one hour after emergence from general anesthesia, the patient experienced progressive difficulty breathing secondary to severe lingual swelling. He required emergent placement of a nasotracheal tube guided by a fiberoptic bronchoscope. He remained intubated for 3 days and was treated with dexamethasone, after which the swelling resolved, and the patient was successfully extubated. Conclusions Acute lingual edema is a potentially life-threatening phenomenon that can lead to rapid airway compromise. Generally, causes of acute lingual swelling include hemorrhage, edema, infarction, and infection. In the case described above, we suspect traumatic injury to the tongue’s vascular supply caused a deep tissue hematoma leading to postoperative acute lingual swelling and airway obstruction. With the widespread use of IONM, it becomes essential for providers to be aware that perioperative airway compromise is a potentially life-threatening complication, especially with respect to monitoring of the hypoglossal nerve. Awake fiberoptic nasotracheal intubation can successfully be employed to establish an emergency airway in such situations.

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Section: Discussionmentioning

confidence: 99%

Acute airway obstruction requiring nasotracheal intubation following hypoglossal neuromonitoring: a case report

et al. 2023

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“…Accidental causes involve accidental injuries not only to the lingual artery and its branches and dorsal lingual, deep lingual, or sublingual artery but also to the submental artery. Injuries due to a fall or stab wounds, among others, have also been reported as causes of traumatic hematomas 15,16. Dental procedures constitute the majority of iatrogenic sublingual hematomas.…”

Section: Methodsmentioning

confidence: 99%

“…Injuries due to a fall or stab wounds, among others, have also been reported as causes of traumatic hematomas. 15,16 Dental procedures constitute the majority of iatrogenic sublingual hematomas. Airway obstruction during periodontal surgical procedures can be possibly caused by mandibular dermal graft vestibuloplasties, biopsies of salivary glands or mucosal lesions, and surgical resection of ranulas or lipomas from the floor of the mouth (FOM).…”

Section: Etiology Of Sublingual Hematomamentioning

confidence: 99%

Vascular Anatomy for the Prevention of Sublingual Hematomas: Life-Threatening Complication of Genioplasty

Choi¹,

Lee

Yun

et al. 2022

Journal of Craniofacial Surgery

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After genioplasty, the occurrence of bleeding is rare; however, rapid enlargement or displacement of the tongue secondary to lingual or sublingual hematoma can lead to life-threatening airway obstruction, necessitating prompt recognition, and immediate management. Therefore, the investigators aimed to evaluate the underlying etiologies of sublingual hematoma and relevant anatomy to facilitate early recognition of the initial presentation of these hematomas and appropriate management. The authors conducted a literature review on cases of delayed sublingual hematoma after genioplasty. The authors also report a case of delayed hematoma after performing genioplasty. The anatomical structures involved with the development of rare and serious hematomas therein are the sublingual and submental arteries, which are located in the sublingual area, rendering them susceptible to injury during genioplasty. The results of this study suggest that submental artery ligation should be performed for proper management of airway obstruction, if symptoms of sublingual bleeding are observed during the surgical procedure. If there is continuous bleeding despite the submental artery ligation, sublingual artery ligation should be performed.

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“…Understanding the complications that could potentially arise following the injury to the neurovascular bundles is critical. Uncontrolled bleeding is one such complication that could arise if the vascular supply in the area is severed accidentally [ 1 , 2 ]. This complication could potentially be fatal if the management of the situation has not been adequately planned.…”

Section: Introductionmentioning

confidence: 99%

“…The anterior mandible is generally believed to be a safe location for dental implants [ 3 ]. However, bleeding complications in the anterior mandible, especially the floor of the mouth, could be fatal if not anticipated in advance and not appropriately planned and managed [ 2 ]. Injury to the vascular supply near the floor of the mouth can cause sublingual hematoma and could substantially cause airway obstruction [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

A Three-Dimensional (3D) Evaluation Unveiling if the Anterior Mandible Is Truly a Safe Zone for Implant Placement

Vyas¹,

Tadinada²

2023

Cureus

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Background Dental implants are increasingly being used in the rehabilitation of the edentulous areas in the maxilla and mandible. The anterior mandible is considered a safe zone for implant placement, but clinicians often find it challenging to control bleeding in this area. This is due to the presence of the sublingual artery, which can be of varying dimensions and can cause severe bleeding. This can be of higher significance in patients with high or uncontrolled blood pressure and in patients on blood thinners like Aspirin or Coumadin where establishing a clot can be difficult. With newer guidelines recommending that medication be discontinued only a few hours before surgery and that bleeding be managed locally, this issue has become even more challenging. With three-dimensional (3D) imaging using cone beam computed tomography (CBCT) becoming more common for implant planning, the presence of the sublingual artery can be evaluated and incorporated into the treatment plan. The objective of this study is to evaluate the 3D location of the sublingual artery in the edentulous anterior mandible of CBCT scans of patients referred for dental implant therapy. Methodology A total of 50 de-identified CBCT scans with an edentulous anterior mandible referred for dental implant therapy were evaluated for this study. Cross-sectional images were generated using a CBCT reconstruction program INVIVO-5 (Anatomage, San Jose, CA, USA). After the sublingual artery was localized, measurement was conducted from a standardized point on the alveolar crest to the artery’s entry point on the lingual aspect. Measurements were also obtained from the terminal point of the artery’s course to the buccal cortical plate. Alveolar crest can either resorb or be subjected to alveoloplasty during implant placement, similar measurements were also done from a standardized point on the inferior cortical border of the mandible to the artery’s entry points on the lingual aspect. Two oral and maxillofacial radiologists conducted all measurements. Results It was found that the median value of the sublingual artery from the alveolar crest to the level of entry (V1) was 6.78, the vertical measurement of the artery coursing into the alveolar bone was ~4.03 mm (V2), the vertical measurement of the artery’s position within the alveolar bone at the terminal point form the crest was ~11.71 (V3), and the inferior vertical measurement from the course of the artery to the inferior border of the mandible was 9.60 mm. The artery extended about ~8.3 mm within the alveolar bone from the lingual cortex (H1), and the artery was located about 4.97 mm away from the buccal cortex (H2). Cronbach’s Alpha test showed high interoperator reliability. Conclusions In this retrospective study, the sublingual artery was noted to be at a critical location in the potential implant site. A site-specific evaluation using CBCT can help in localizing and avoiding perforation of the sublingual arte...

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Life-Threatening Expansive Sublingual Hematoma

Cited by 8 publications

References 27 publications

Acute airway obstruction requiring nasotracheal intubation following hypoglossal neuromonitoring: a case report

Acute airway obstruction requiring nasotracheal intubation following hypoglossal neuromonitoring: a case report

Vascular Anatomy for the Prevention of Sublingual Hematomas: Life-Threatening Complication of Genioplasty

A Three-Dimensional (3D) Evaluation Unveiling if the Anterior Mandible Is Truly a Safe Zone for Implant Placement

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